VoucherClub NZ Limited AUTHORITY FOR
AUTOMATIC PAYMENTS
(Not to operate as an assignment or agreement)
PAYER DETAILS
Name of Bank Branch
   
Address Name of Account
   
  • This is a New Authority.
Account details
Bank Branch No Account No Suffix
                               
Details to appear on my/our bank statement:
Particulars Code Reference
V C N Z L                                
FREQUENCY AND AMOUNT
First Payment Date Frequency Until
         /         /          Until further notice

Fixed Amount Amount in Words
$  
PAYEE DETAILS
Name of Bank Branch
ANZ BANK Frankton
Name of account Branch Branch No Account number Suffix
VCNZ Limited 0 1 0 3 1 1 0 1 2 9 8 4 8 4 7  
Details to appear on payee's bank statement: ie Your e-mail address and name if possible, without dots or @ sign.
Particulars Code Reference
                                         
AUTHORISATION
1. Please make this automatic payment as detailed by debiting my/our account.
2. I/We understand and accept that the Bank accepts this authority that I/we know the conditions of this authority.

Name of account: .........................................................................



(Customers Signature)         (Contact Phone No)         (Date)